Forms

Loss of Life caused solely by external, violent, and accidental means.

Member / Spouse / Dependents

Loss of Life caused solely by external, violent, and accidental means while on the premises of your employer.

Member Only

Accidental Dismemberment caused solely by external, violent, and accidental means.

Member / Spouse / Dependents

Accidental Dismemberment caused solely by external, violent, and accidental means while on the premises of your employer.

Member Only

If Member wishes to Authorize an Individual to speak on their behalf.

Member Only

Replace lost wages in an event you missed work due to a death in the family or the birth of your child.

Member Only

Confidential access to Oncology Nurses to help navigate the healthcare system.

Member / Spouse / Dependents

Up to $50,000 per Eligible Dependent Child.

Dependent Child

Information about your Critical Illness Coverage.

Member / Spouse / Dependents

Information on how to set up eClaims.

Member / Spouse / Dependents

Diagnostics Services:
MRI / CT Scans / Ultrasound / Endoscopy / Colonoscopy

Specialists Services:
Dermatologist, Endocrinologist, Gynecologist, Podiatrist, Respirologist, Cardiology, Gastroenterology, General Surgery, Neurosurgery, Ear, nose & throat, Orthopedics, Ophthalmology, Rheumatology, Urology, Neurology

Surgeries Services (MEMBER ONLY):
Orthopedic Surgery – ACL, Elbow, Foot, Ankle, Toe, Hand, Wrist, Hip, Knee & Shoulder
General Surgery – Cataract, Ear, Nose & Throat, Gallbladder & Hernia

Member / Spouse / Dependents

Access to tools / information to assist in educating and providing guidance for financial goals and assist in alleviating stress from financial uncertainty.

Member / Spouse / Dependents

Information about your Group Legal Plan Coverage

Member / Spouse / Dependents

Confidential one-on-one coaching support around healthy eating, diabetes, and heart health.

Member / Spouse / Dependents

Access to Nurses to help navigate the healthcare system.

Member / Spouse / Dependents

Intensive outpatient program offered virtually or in-person to address a variety of mental health issues and disorders.

Member / Spouse / Dependent Child

Confidential counselling services to support mental health and wellbeing.

Member / Spouse / Dependent Child

Confidential counselling services to support mental health and wellbeing.

Member / Spouse / Dependents

Mental health resources, assessment tool, and confidential counselling services.

Member / Spouse / Dependents

Confidential access to virtual or in-person treatment to address opioid use and addiction.

Member / Spouse / Dependent Child

Resources and coaching services to tackle a variety of parenting and caregiving challenges.

Member / Spouse

Information about your Permanent Total Disability Accident Coverage

Member / Spouse / Dependents

Online training platform to tackle a variety of lifestyle goals, including smoking cessation, weight loss, sleep, alcohol, stress, diabetes, and more.

Member / Spouse / Dependents

Confidential virtual support, coaching, and treatment to address alcohol, opioid, and substance use and addiction.

Members / Spouse / Dependent Child

Information on all substance use and addiction treatment programs.

Member / Spouse / Dependents

Information about Tax Services.

Member / Spouse / Dependents

Online platform for Non-Emergency Medical Support.

Member / Spouse / Dependent Child

Claim form for Child Disability Benefit.

Dependent Child

Claim for Critical Illness Diagnosis for Dependent Child Only – Cerebral Palsy, Congenital Heart Disease, Cystic Fibrosis, Down Syndrome, Muscular Dystrophy, Type 1 Diabetes.

Dependents Only

Claim for Critical Illness Diagnosis – Bacterial Meningitis, Benign Brain Tumor, Coma or Stroke.

Member / Spouse

Claimant Statement for Critical Illness Diagnosis (to be completed for all CI illnesses)

Member / Spouse

Claim for Critical Illness Diagnosis – Heart Related Conditions

Member / Spouse

Claim for Critical Illness Diagnosis – Kidney Failure Major Organ Transplant or Failure on Waiting List, or Aplastic Anemia.

Member / Spouse

Claim for Critical Illness Diagnosis – Loss of Sight, Hearing, Speech, Limbs, Independent Existence or Paralysis.

Member / Spouse

Claim for Critical Illness Diagnosis – Muscular Dystrophy

Dependents

Claim for Critical Illness Diagnosis – Neurologic Disorders

Member / Spouse

Claim for Critical Illness Diagnosis – Occupational HIV Infection

Member / Spouse

Claim for Critical Illness Diagnosis – Cancer

Member / Spouse

If member wishes to apply or withdraw from the dental clinic

Member Only

Claim form for all dental care expenses.

Member / Spouse / Dependents

Benefit coverage application for dependents with a disability.

Dependents

Complete a direct deposit form to have your claim cheques deposited directly into your bank account.

Member Only

Disabled and unable to work? Complete the Disability Self Pay Extension form to request to self pay for benefit coverage.

Member Only

Claim form to apply for emergency out-of-province medical coverage

Member / Spouse / Dependents

Claim for all heath care expenses which includes prescription drugs.

Member / Spouse / Dependents

Claim form for legal benefits related to Adoption

Member / Retiree

Claim form for legal benefits related to Change of Name.

Member / Retiree

Claim form for legal benefits related to Child Support

Member / Retiree

Claim form for legal benefits related to Custody

Member / Retiree

Claim form for legal benefits related to Divorce

Member / Retiree

Claim form for legal benefits related to Separation Agreement

Member / Retiree

Been hospitalized? Claim for a daily cash benefit for the duration of your hospital stay to cover for parking, room amenities, etc.

Member / Spouse / Dependents

Replace lost wages in an event you missed work due to jury duty.

Member Only

Claim form for legal benefits related to the Highway Traffic Act (HTAO)

Member / Retiree / Spouse

Claim form for legal benefits related to Immigration.

Member / Retiree / Spouse

Claim form for legal benefits related to Wills and Power of Attorney

Member / Retiree / Spouse

Advance lump sum of principal life insurance amount paid in advance

Member / Spouse / Dependents

Claim in the event of a death.

Member / Spouse / Dependents

Claim for Long Term Care Benefits if you or your eligible spouse require support with activities of daily living at home or at long term care facility.

Member / Eligible Spouse

If you remain totally disabled and have exhausted the Short-Term Disability Benefit.

Member Only

Complete this Prior-Authorization form prior to claiming for medicinal cannabis.

Member / Spouse / Dependents

Moving and looking to change your home address? Complete the Member Change of Address Form

Member Only

New Member Enrollment / Application card or to add / change existing dependents and beneficiaries.

Member Only

If you require out of hospital home nursing.

Member / Spouse / Dependents

If you become totally and permanently disabled due to an accident.

Member Only

Claim form for legal benefits related to Real Estate Discharge

Member / Retiree / Spouse

Claim form for legal benefits related to Real Estate Mortgage

Member / Retiree / Spouse

Claim form for legal benefits related to Real Estate Purchase

Member / Retiree / Spouse

Claim form for legal benefits related to Real Estate Sale

Member / Retiree / Spouse

Claim form for legal benefits related Real Estate Transfer of Title

Member / Retiree / Spouse

If member wants to set up an RESP for child / grandchild

Member Only

Lost / Misplaced your Member Advantage Benefit Card? Complete the Replacement Benefit Card Application to request a new card.

Member Only

Income replacement if you are unable to work due to non-occupational injury or illness.

Member Only

Hospital, Surgeon, Physician Fees

Members / Spouse / Dependent Child
Up to age 70

Claim for member only of $100,000

Member Only

Physician to complete the Speech Therapy Medical Questionnaire for dependent children prior to incurring speech therapy claims. Benefit available to dependent children only.

Dependent Children Only

Complete this form if you are transferring Locals and are moving your dollar bank.

Member Only

Complete this form if you are transferring Locals and are moving your hour bank.

Member Only

Claim a medical emergency while travelling.

Member / Spouse / Dependents

Member wanting to withdraw vacation pay monies.

Member Only